Congenital Absence of the Epiglottis in a 35 Years Old Patient.

Absent epiglottis is a rare reported anomaly in adults with unknown incidence. Most patients with absent epiglottis have presented with life-threatening symptoms of respiratory distress or severe aspiration in infancy or early childhood. We report a case of a 35 year old male patient with complete absence of epiglottis, presented with complaint of hoarseness of voice since birth.

Outcomes of Total Laparoscopic Hysterectomy: A Single-Surgeon Experience of Initial 50 Cases.

Introduction In this study, we reported a single surgeon experience of total laparoscopic hysterectomy (TLH) in terms of intraoperative and early postoperative outcomes and complications. In addition, we compared our results with published literature for a reevaluation of complications and outcomes. Material and methods This present prospective study was conducted on 50 patients who underwent TLH due to benign causes. Patients diagnosed with abnormal uterine bleeding (AUB), uterine fibroids, and post-menopausal bleeding (PMB) were included in this analysis. Patients were discharged after 24 hours of surgery if there were considered fit for discharge. The patients' age, co-morbidities, size of the uterus, additional procedure along with TLH, and postoperative complications were collected and analyzed. The follow-up period was three months, done on the tenth day after surgery, the thirtieth day, and then at three months. Results The mean age of our patients was 46.42±5.01 years. The major indication of hysterectomy was fibroids diagnosed in 27 (54.0%) patients and AUB in 18 (36.0%) patients. Out of 50, 10 (20.0%) patients had a previous cesarean section, and 4 (8.0%) had a bilateral tubal ligation (BTL). Mean surgery duration was 124.26±44.74 minutes. Mean hospital stay was 2.18±0.39 days. Total complications occurred in five (10.0%) patients, ureteric injury in one (2.0%) patient, port-site infections in 2 (4.0%), and vault infections in 2 (4.0%) patients. Conclusion TLH is a safe procedure and can be performed with minimal complications in patients with benign uterine etiology.

Kisspeptin and attributes of infertile males and females: A cross-sectional study in a subset of Pakistani population.

Kisspeptin, a peptide hormone, plays a pivotal role in fertility and neuroendocrine regulation of hypothalamo-pituitary-gonadal axis. Increased kisspeptin and reproductive hormones are responsible for fertility in male and females. This study aimed to explore the role of kisspeptin on hypothalamo-pituitary-gonadal axis by comparing the levels of kisspeptin in fertile and infertile subjects and identifying single nucleotide polymorphisms (SNPs) of KISS1 gene in exon 2 and exon 3 of infertile male and female cohorts. A cross-sectional study was carried out on 80 males (44 infertile and 36 fertile) and 88 females (44 in each group). Significantly high levels of kisspeptin (KP), follicle-stimulating hormone (FSH), luteinizing hormone and testosterone were observed in fertile male and female subjects except low FSH levels in comparison with infertile female subjects. One polymorphism in exon 2 (E1225K [G/A 3673]) and three in exon 3 (P1945A [C/G 5833]; Insertion of T at 6075; G2026G [C/G 6078]) in infertile group were detected, with low KP and hormonal levels. Male subjects had abnormal sperm parameters and unsuccessful attempt of intracytoplasmic sperm injection in females. Expression of SNP in exon 2 and exon 3 of KISS1 could be responsible for alteration in release of reproductive hormones and gonadal functions, hence causing infertility.

Successful intravaginal culture of human embryos for the first time in Pakistan--an experience at the Sindh Institute of Reproductive Medicine, Karachi.

Approximately 10-15% of the married couples remain childless. Conventional in vitro fertilisation (IVF) has been the treatment option for most of these cases. However, it is expensive and only available to a small fraction of the infertile population. The Sindh Institute of Reproductive Medicine (SIRM), Karachi, Pakistan, has introduced a new method of IVF for the first time in Pakistan. Intravaginal culture (IVC) is a simple, reliable and cost-effective alternative to IVF. The procedure can be performed in an office set-up with minor capital equipment. Here, we report a case of a subfertile woman treated by IVC, which resulted in successful fertilisation of the eggs (fertilisation rate 71.42%) and embryo development, with an intrauterine pregnancy. Since this is the first successful case of IVC in Pakistan, comparative success rate and take-home baby rate have yet to be established.

Cryopreservation of embryos by vitrification at a private sector reproductive medicine facility in Karachi.

OBJECTIVE: To assess the survival of freezing cleaved human embryos through vitrification. METHODS: The prospective study was conducted at the Karachi-based Sindh Institute of Reproductive Medicine between June 2008 and June 2009. The cryopreservation of embryos being a new technology in Pakistan, only 19 couples, picked through convenience sampling, comprised the study population. The couples were treated for infertility by in virto fertilisation (IVF) or intracytoplasmic sperm injection (ICSI); 125 surplus embryos were vitrified. Subsequently, 15 embryos were thawed, and transferred in a controlled cycle. SPSS version 11 was used for statistical analysis. RESULT: After the surplus embryos were vitrified and subsequently thawed and transferred, the survival of the embryos was assessed by the number of blastomeres that were intact. The overall embryo survival rate was (14/15) 93.33%. CONCLUSION: Vitrification is a simple procedure that requires less time and is likely to become safer and more cost-effective with time. Survival rate after thawing and preserving is high, but comparative success rates in terms of pregnancy and taking-home-baby rates are yet to be established in Pakistan.

Clinical results of the intra-cytoplasmic sperm injection with surgically retrieved sperms in azoospermic men at Sindh Institute of Reproductive Medicine, Karachi.

OBJECTIVE: To analyse the result of intra-cytoplasmic sperm injection (ICSI) by using surgically retrieved sperms in the azoospermic male. METHODS: Eight (9 cycles) azoospermic men were given the intra-cytoplasmic sperum injection after sperms were collected through surgical retrieval either by percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE) at the Sindh Institute of Reproductive Medicine (SIRM), Karachi, which is an assisted reproductive technology centre. Fertilisation, cleavage and pregnancy rates were calculated in their spouses with surgical sperm collection (SSC) and intra-cytoplasmic sperm injection. The study related to the period between September 2007 and February 2009. Statistical analysis were done using SPSS version 11.0. RESULT: After the intra-cytoplasmic sperm injection procedure, fertilisation rate of 72.72% and cleavage rate of 78.12% were achieved in the eight patients. A total of 3 (33.33%) clinical pregnancies were obtained through the transfer of embryo from surgical sperm collection in the azoospermic men. CONCLUSION: Intra-cytoplasmic sperm injection with surgical sperm collection proved to be the only successful treatment for men with azoospermia. It gave 33.33% chances of fatherhood in men who were previously labelled infertile. Results were found to be promising and are expected to improve with time and experience.

Metal tolerance and biosorption potential of filamentous fungi isolated from metal contaminated agricultural soil.

Heavy metal analysis of agricultural field soil receiving long-term (>20 years) application of municipal and industrial wastewater showed two- to five-fold accumulation of certain heavy metals as compared to untreated soil. Metal-resistant fungi isolated from wastewater-treated soil belonged to genera Aspergillus, Penicillium, Alternaria, Geotrichum, Fusarium, Rhizopus, Monilia and Trichoderma. Minimum inhibitory concentrations (MIC) for Cd, Ni, Cr, Cu, and Co were determined. The MIC ranged from 0.2 to 5 mg ml(-1) for Cd, followed by Ni (0.1-4 mg ml(-1)), Cr (0.3-7 mg ml(-1)), Cu (0.6-9 mg ml(-1)) and for Co (0.1-5 mg ml(-1)) depending on the isolate. Aspergillus and Rhizopus isolates were tested for their metal biosorption potential for Cr and Cd in vitro. Biosorption experiments were conducted with initial metal concentrations of 2, 4, 6 and 8 mM with a contact time of 4 h and wet fungal biomass (1-5 g) at 25 degrees C. Maximum biosorption of Cr and Cd ions was found at 6 mM initial metal concentration. Aspergillus sp.1 accumulated 1.20 mg of Cr and 2.72 mg of Cd per gram of biomass. Accumulation of these two metals by very tolerant Aspergillus sp.2 isolate was at par with relatively less tolerant Aspergillus sp.1 isolate. Rhizopus sp. accumulated 4.33 mg of Cr and 2.72 mg of Cd per g of biomass. The findings indicated promising biosorption of cadmium and chromium by the Rhizopus and Aspergillus spp. from aqueous solution. There is little, if any, correlation between metal tolerance and biosorption properties of the test fungi.